Individual
MS. LISA MARIE POLHAMUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
501 6TH AVE S, ST PETERSBURG, FL 33701
(727) 767-4313
(727) 767-4391
Mailing address
501 6TH AVE S, ST PETERSBURG, FL 33701-4634
(727) 767-4313
(727) 767-4391
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
ARNP9481675
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024415700
—
FL
Enumeration date
06/18/2008
Last updated
06/20/2018
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